Legislation to repeal Obamacare and replace major portions of the healthcare program will be unveiled after a 10-day US House of Representatives recess that begins this week, House Speaker Paul Ryan said on Thursday (February 16, 2017).

Republicans, who control both House and Senate, have been struggling to come up with a detailed plan for replacing former Democratic President Barack Obama’s signature domestic policy that they have vowed to repeal.

“After the House returns following the Presidents Day break, we intend to introduce legislation to repeal and replace Obamacare,” Ryan said at his weekly press conference.

Ryan spoke shortly after many House Republicans huddled in a closed session with newly-installed Health and Human Services Secretary Tom Price to discuss Obama’s 2010 Affordable Care Act and their options to change it. The session was part pep talk and part laying out of talking points that can be delivered to constituents during the recess, says Reuters.

Lawmakers left the meeting saying there was plenty more work ahead on thorny issues, including squeezing savings from Medicaid and possibly cutting some healthcare tax credits. Republican President Donald Trump’s administration has gone through a succession of controversies since he was sworn in on Jan. 20, including his travel ban on immigrants and refugees from seven predominantly Muslim countries, while Republicans in Congress labored over replacing Obamacare and reforming an outdated tax system.

Hoping to quell any jitters, Tom Price, who served in the House before becoming HHS secretary, told Republican lawmakers, according to a source who attended the meeting, that on the Obamacare repeal,

“The president is all in on this…let’s go shoulder to shoulder, arm to arm,”

But they do not know yet what exactly they will be joining forces on. House Ways and Means Committee Chairman Kevin Brady told reporters there are “a range of options” for giving states more say over the operation of Medicaid, which has become an important tool for delivering medical coverage under Obamacare. Brady said there were also various options for ways to offset the costs of a Republican plan, such as capping the tax exclusion for employer-based healthcare plans.

Also last week, after characterizing Obamacare as an abject failure, a white paper drafted by House leadership and the staff of the House and Senate committees that oversee health policy describes a structure that could replace large sections of the Affordable Care Act.

Unlike Obamacare, the Republican plan would substantially cut funding for states in providing free insurance to low-income adults through Medicaid. And it would change how tax credits are distributed by giving all Americans not covered through work a flat credit by age, regardless of income.

Steve’s Take:

In the face of an unprecedented wild and wacky beginning to his administration, President Trump over the weekend trumpeted, “the White House is running so smoothly.” Fair enough. He’s certainly entitled to his opinion, being the one in charge of that hallowed residence.

The problem, however, is that Congress, the press corps and federal government employees are trying mightily, but to a large extent unsuccessfully so far, to keep pace with an eccentric, erratic chief executive with no prior governing experience at any level outside his business empire.

This is problematic as GOP promises (and efforts the past seven years) to replace Obamacare with “something much better” and far cheaper cannot go unfulfilled any longer without dire political consequences.

So House Republicans headed home for a one-week recess with a new outline of their plans for repealing and replacing Obamacare, but the document leaves many key questions unanswered.

The memo was shared with lawmakers after a closed-door briefing, and is aimed at helping members who have faced some tough questions about their Obamacare plans in recent weeks. For now, it appears “Republican lawmakers are still in the education phase,” says The Hill.

“There was no attempt to come to a consensus today; today was more informational,” Rep. Morgan Griffith (R-VA), who sits on the Energy and Commerce Committee, said.

House Energy and Commerce Chairman Greg Walden (R-OR) and Ways and Means Chairman Kevin Brady (R-TX) outlined Obamacare replacement items leadership wants to include in its bill gutting major provisions of the ACA. These include how to reform Medicaid and deal with the states that chose to expand the program; tax credits to help Americans pay for insurance; high-risk pools; and health-savings accounts.

“I think the membership is going to have to have time to digest a lot of this,” Griffith said.

To be clear, legislative text hasn’t yet been released, so the details are once again limited. Speaker Paul Ryan (R-WI) said he’s waiting on scores from the Congressional Budget Office before unveiling a bill. Ryan has previously said he plans to repeal and replace parts of Obamacare by spring.

“If you look at what the Republican proposals are–advancing refundable tax credits, getting power back to the states, general guidelines of where we should be instead the federal government prescribing them–there is so much common ground,” insisted Sen. Bill Cassidy (R-LA). “It’s 90 percent there.”

But instead of a groundswell of support for a single bill, alternatives are mushrooming, says Politico. There’s the plan from Sens. Cassidy and Susan Collins, which would give states the ability to craft their own healthcare plans, including keeping Obamacare. There’s Sen. Rand Paul’s proposal, which mostly scraps Obamacare with minimal replacement. The House Freedom Caucus wants to introduce its own bill similar to Paul’s. And Rep. Darrell Issa (R-CA) wants to just open up the federal employee healthcare plan to all Americans.

Sound familiar? There’s more. And it epitomizes the root problem.

In short, many Republicans are looking to the White House to provide some guidance before weighing in. Guidance? What’s unclear about an Obamacare replacement plan that’s “much better” and far cheaper, according to Mr. Trump?

“It’s hard to see how this gets done unless the president says, ‘OK, let’s do it this way,’” said Sen. Lamar Alexander (R-TN), chairman of the Senate Health, Education, Labor and Pensions Committee. “We’ve got our own ideas and we’ll pass our own bill, but it’s hard to do anything this complex unless the president is directly involved.”

Once Trump releases a plan–any plan–Republicans on Capitol Hill hope to use it to write their own bill, Alexander said, pointing to the McConnell-Ryan working group, which first met several weeks ago.

“The result of that meeting was a more structured process between the Senate and House staffs. We’re making good progress,” Alexander said.

The Tennessee senator has met Trump only once, though he and other Republicans headed to the White House on Thursday for lunch with the president and moderate Democratic senators.

Republican leaders hope that the Trump plan–and the leadership-driven bill that follows–will clear the crowded field of health plans. Hope springs eternal, apparently.

But will Republicans be able to pass a sweeping bill after criticizing Democrats for doing so with Obamacare? Several senators said no, they believe they will have to pass a series of piecemeal measures, starting with rolling as much replacement language as possible into a repeal bill passed with all GOP votes. At the same time, they’ll look to Price to make changes to the legislation before they try to work with Democrats to pass more healthcare laws with a 60-vote threshold in the Senate.

Those bills will have to fix the staggering insurance market exchanges, preserve healthcare coverage for millions of Americans under Medicaid expansion and provide better healthcare plans to people for lower costs, all without gashing the budget. And executing all of it is proving just as daunting as it sounds, to say the least.

“There’s talk of just totally excluding–not in the Senate, but on the House side–Medicaid expansion. That’s 184,000 people in my state,” said Sen. Shelley Moore Capito (R-WV). “That’s problematic.”

Bottom line:

So where does that leave those of us trying to separate the wheat from the chaff, or more bluntly, the truth from the fake stuff?

For approximately the umpteenth time, we are being assured that congressional Republicans and now possibly Mr. Trump himself—okay, let’s get real–Secretary Price, are fully engaged with working on it. Anytime now, quips The Daily Kos.

They’ve got so many ideas. Good ideas, all. Fabulous ideas, in fact. Just a little fine-tuning and Trump, Ryan and McConnell will get the entire peevish Republican Party shoulder-to-shoulder on the same page and make this thing happen. Right after they get back from recess. Really soon after.

Here’s the rub.

The restructuring elements presented Thursday clearly are subject to major internal debates among Republicans. Medicaid, for instance, is a flash point between hard-line conservatives who want to significantly roll back federal spending and members from states that took advantage of the ACA’s Medicaid expansion and are now wary of reducing coverage.

If that’s not intimidating enough, another huge chasm concerns how to structure tax breaks to encourage individuals to buy insurance plans. Speaker Ryan and other House leaders say they favor refundable tax credits, while many conservatives say they prefer less expansive–and expensive–tax deductions.

As for timing, Ryan says later this month, after the recess this week. Rep. Patrick J. Tiberi (R-OH) says “To be determined.”

Popular-vote loser Trump, however, says, “We’re doing Obamacare. We’re in final stages. We should be submitting the initial plan in March, early March, I would say…So we’ll be submitting health care sometime in early March, mid-March.”

Or, you know, sometime. You can quote me.

Oh, and remember the rest of us? You know, the at-large consumers and taxpayers, the insurers, healthcare providers, pharma companies and rest of the healthcare industry, and entire United States of America. What should we expect? Perhaps nothing; or no totally new thing.